Aboriginal and/or Torres Strait Islander Health

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How to identify Aboriginal and Torres Strait Islander Patients
Indigenous Health Incentive
Immunisation

Closing the Gap

The life expectancy of Aboriginal and Torres Strait Islander people is some 10 to 17 years less than other Australians. Aboriginal and Torres Strait Islander people experience a burden of disease two-and-a-half times that of other Australians.

A large part of the burden of disease is due to chronic diseases such as:

  • Cardiovascular disease
  • Diabetes
  • Chronic respiratory disease
  • Chronic kidney disease
  • Cancer
  • Mental Health

This can be reduced by earlier identification, and management of risk factors and the disease itself.

The Australian Government has implemented a range of health initiatives including:

Improving Indigenous Access to Mainstream Primary Care Program Rationale
Mainstream primary care is the first point of call for health services for most Australians; however cultural barriers can limit the use of these services by Aboriginal and Torres Strait Islander people. The Closing the Gap: Improving Indigenous Access to Mainstream Primary Care Program aims to ensure that mainstream primary care services (including but not limited to General Practice, Allied Health, and Specialists) are able to provide culturally sensitive care for Aboriginal and Torres Strait Islander people.  Increasing the capacity of mainstream primary care to provide such services will increase the options available for Aboriginal and Torres Strait Islander peoples.

The intended outcomes include:

  • an increase in the overall health of Aboriginal and Torres Strait Islander population;
  • improved access to culturally sensitive primary care services for Aboriginal and Torres Strait Islander people; and
  • improved management of chronic conditions in Aboriginal and Torres Strait Islander people

Objectives
The objectives of the program are to:

  • Increase access to mainstream primary care services by Aboriginal and Torres Strait Islander peoples;
  • Improve the capacity of General Practice to deliver culturally sensitive primary care services;
  • Increase the uptake of Aboriginal and Torres Strait Islander peoples specific Medical Benefits Scheme (MBS) items including Aboriginal and Torres Strait Islander health checks and follow-up;
  • Support mainstream primary care services to encourage Aboriginal and Torres Strait Islander people to self-identify;
  • Increase awareness and understanding of Closing the Gap measure relevant to mainstream primary care; and
  • Foster collaboration and support between the mainstream primary care and the Aboriginal and Torres Strait Islander health sector

South East Alliance of General Practice (Brisbane)
The South East Alliance of General Practice has approximately 4,877 Aboriginal and Torres Strait Islander people which equal 1.41% (ABS data June 2006) In the City of Redland Aboriginal and Torres Strait Islander people currently comprise 1.5% of the City’s population. This is comparable to Brisbane (1.4%), but significantly less than that for Queensland (3.3%). In 2006, 1,934 Redland City residents identified as Indigenous. The most significant communities (numbers of Aboriginal and Torres Strait Islander residents) of Indigenous people were located at North Stradbroke Island, Capalaba, Alexandra Hills and Victoria Point.

Over the last ten years, the Indigenous population of Redland City increased by over 600 people, with the most significant increases in Alexandra Hills, Capalaba and Victoria Point

SEA-GP Is currently working closely with a number of practices to improve access and chronic disease measures for Aboriginal and Torres Strait Islander patients. These practices are in areas of identified need and we will be increasing the number of Practices throughout the program.

National Close the Gap Day - SEA-GP & Redland City Council held a tree planting in Capalaba Regional Park to symbolise their commitment to close the life expectancy gap. March 2011 - Press Release - Bayside Bulletin article.

For more information contact the SEA-GP Closing the Gap Program Officers.

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How to identify Aboriginal and Torres Strait Islander Patients

Why ask
The establishment of a client’s cultural background may have diagnostic significance and so should be part of routine medical history taking. In the case of Aboriginal and Torres Strait Islander patients, this inquiry is also relevant to eligibility for services such as the health check items and specific immunisation programs.

How to ask
Practitioners should ensure that each person attending their practice has the opportunity to identify if they are Aboriginal and Torres Strait Islander. An environment which maintains confidentiality and provides an explanation of this question if requested will assist this process.

Aboriginal and/or Torres Strait Islander Status cannot be determined by looks alone.

You cannot assume Aboriginal and Torres Strait Islander status; the only sure way is to ask.

The following standard question should be asked of all patients who attend the practice:

Are you of Aboriginal or Torres Strait Islander origin?
(For persons of both Aboriginal and Torres Strait Islander origin, mark both 'yes' boxes.)
No
Yes, Aboriginal
Yes, Torres Strait Islander

This question has been developed by the Australian Bureau of Statistics and has been adopted as the national standard for collecting Aboriginal and Torres Strait Islander origin in administrative data collections.

Information on Aboriginal and Torres Strait Islander origin should be collected as part of completing other registration information (for example Name, address, sex, date of birth, next of kin, etc).  The collection and verification of the information must form part of the normal work practices of all staff members.  The question may be asked by the GP as part of the routine history taking at first consultation, or by the receptionist or other staff members.

  • New Patients

New Patient Form - Patients can be asked to fill out standard questions relating to their personal details and medical history.  The personal details section should include the Indigenous question above.

  • Existing Patients

Patients can be provided with a print out of their currently recorded details or a patient update form and asked to check if the details are correct. If the indigenous status of a patient was not stated, this is an opportunity for the patient to provide this information.

Information management systems used by General Practice should then be updated with the newly supplied patient information. Recording this information in your software allows you to search your database for these patients, providing:

  • an opportunity to provide services to meet their needs, improving quality of care and health outcomes (e.g. such as providing preventative care through Immunisation, Health Checks etc)
  • evidence for accreditation purposes that you are recording self-identified Aboriginal and Torres Strait Islander patients in active health records

 

What if a person does not want to answer the question?
While all practices should record Aboriginal and Torres Strait Islander status in patient files, in most service contexts clients are not obliged to provide this information if they choose not to.  In general, clients or patients who initially refuse to provide this information should be reassured that:

  • the information will not affect their access to services;
  • this information is collected on all patients;
  • it is important information for ensuring appropriate services are provided; and
  • the information will remain confidential.

The patient can be given a further opportunity to answer the question, but again, is not required to do so.

RACGP - updated position statement on
Identification of Aboriginal & Torres Strait Islander people in Australian general practice.

Practice Staff training tips for collecting indigenous status of patients
These tips cover the basic competencies Practice staff will need to correctly collect the Indigenous status of patients, as recommended in the Best Practice guidelines from Australian Institute of Health & Welfare (AIHW):

 

For more information contact the SEA-GP Closing the Gap Program Officers.

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What can you do - Strategies to support integration of identification into practice management.

  • Raise awareness of the link between ethnicity and quality care.

Emphasising the clinical importance of identification is likely to be a key motivator for improved practice among GPs and practice staff.

  • Create an Aboriginal and Torres Strait Islanders ‘friendly’ environment.

This could include having promotional materials such as posters and pamphlets in practice waiting/consulting rooms, as well as displaying Aboriginal and Torres Strait Islander art and/or flags

  • Include questions about Indigenous status as part of patient registration forms.

Ensure that this information is visible to clinicians.

  • Update patient information regularly, including indigenous status, to enable pre-existing patients to identify their status.

Practice staff may feel that introducing identification measures for existing patients would be more difficult than for new patients. Including this information in regular updates of all patient information will address these issues with minimal additional burden

  • Implement quality assurance measures to follow up missing data

Practice staff need to be provided with a ‘script’ that helps formulate how they should ask each patient about their ethnicity if this is not filled out by new patients or existing patients and also includes responses to provide if they are queried or challenged

  • Consider embedding questions about Indigenous status in more general questions about ethnicity.

For practices servicing diverse populations this would be more useful than asking about indigenous status alone

  • Use standard questions to enquire about Indigenous status and/or ethnicity (e.g. ABS format provided above or SAND template for questions around ethic background followed a question on indigenous status)
  • Provide patients with an explanation for why they are being asked about their social history that highlights the relevance to their quality of care. Patients may not understand that questions about their Aboriginality are intended to improve the quality of their care
  • Have clear practice policy and guidelines regarding identification and encourage staff members to do the best they can to make sure that everyone completes new patient registration form, patient update forms and missing data

Remember: If you do not feel comfortable asking the question the patient will sense this and will not be comfortable answering the question.

The above recommendations are taken from the Lowitja Institute and the Australian National University publication “Improving Identification for GP Services”.  Link to report: Kelaher,M., Parry, A., Day, S., Paradies, Y. & Solomon L. 2010, Improving the Identification of Aboriginal and Torres Strait Islander People in Mainstream General Practices. The Lowitja Institute, Melbourne

Cultural Protocols for General Practice

A simple guide for General Practices of protocols, important dates, terminology including common words and words not to use and kinship.

For further information, please contact the SEA-GP Closing the Gap Program Officers.

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Indigenous Health Incentive 

The PIP Indigenous Health Incentive aims to support general practices and Indigenous health services to provide better health care for Aboriginal and Torres Strait Islander patients, including best practice management of chronic disease. This incentive is a key part of the Council of Australian Governments (COAG) National Partnership Agreement on Closing the Gap: Tackling Indigenous Chronic Disease.

Guidelines & IHI PIP Application

Tip sheets on how to register patients for Closing the Gap in medical software:

Tip sheet CTG IHI PIP templates in Best Practice

PDF & RTF versions

Cultural Awareness Training

To be eligible for the Indigenous Health Incentive Practice Incentive Payment (IHI PIP) a minimum of 1 GP and 1 practice staff member has to complete accredited cultural awareness training.

There are currently three options:

  1. RACGP online indigenous health education activity “Introduction to Aboriginal and Torres Strait Islander cultural awareness in general practice” is available at www.gplearning.com.au for members and www.clined.com.au for non‐members. It is free of charge for practices participating in the IHI and GPs through the QI&CPD program.
  2. ACRRM's online cultural awareness training module is ‘Cultural Awareness Online’ and covers major topics in health care and some practical ‘how-to’ advice on collaborative and respectful health care with Indigenous patients. The fees for the online course start from $100 for members. More information is on Courses and Events on the ACRRM website.
  3. SEA-GP is also providing accredited Cultural Awareness Training. Refer flyer for further information, or please contact the SEA-GP Closing the Gap Program Officers.

 

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MBS Item Numbers for Aboriginal and Torres Strait Islander

GMSBML MBS flowchart – claiming pathway for Aboriginal and Torres Strait Islander Patients
GMSBML MBS items numbers for Aboriginal and Torres Strait Islander Patients business case

Current as at 1 Nov 2010

Health Assessments

Item 715: Aboriginal and Torres Strait Islander Health Assessment

Available to all Aboriginal and/or Torres Strait Islander people, but requirements vary according to age group: 0-14, 15-54, and 55+ years of age.

Fee* Benefit Where Frequency

$200.20

100% =$200.20

Place other than a hospital or residential aged care facility

Once in a 9 month period

MBS health assessment resource kits containing additional information and proformas are available. Proformas provide useful guidance, but are not mandatory to claim items as long as all requirements are met.

Item 10987: Follow-up service by a Practice Nurse or registered Aboriginal Health Worker

Follow-up services for an Aboriginal and/or Torres Strait Islander person who has received a health assessment.

Fee* Benefit Frequency

$23.10

100% = $23.10

Maximum of 10 services per year

Patient eligibility

Item 10987 may be accessed by an Aboriginal and/or Torres Strait Islander patient who has received a health assessment (e.g. an Aboriginal and Torres Strait Islander Health Assessment (Item 715).

Eligible practitioners
Item 10987 may be claimed by a medical practitioner, where a follow-up service is provided by a practice nurse or registered Aboriginal Health Worker on behalf of that medical practitioner for an Aboriginal and/or Torres Strait Islander person who has received a health assessment.

Item description
Item 10987 may be used to provide:

  • examinations/interventions as indicated by the health assessment;
  • education regarding medication compliance and associated monitoring;
  • checks on clinical progress and service access;
  • education, monitoring and counselling activities and lifestyle advice;
  • taking a medical history; and
  • prevention advice for chronic conditions, and associated follow-up.

To claim this item, the following criteria must be met:

  • the service is provided on behalf of and under the supervision of a medical practitioner;
  • the person is not an admitted patient of a hospital; and
  • the service is consistent with the needs identified through the health assessment.

Items 81300 to 81360: Allied health services
Available to any Aboriginal and/or Torres Strait Islander person who has had a health assessment during which the need for follow-up allied health services has been identified.

Fee* Benefit Frequency

$59.90

85% = $50.95

Maximum 5 health services per year

 

Patient eligibility
A person who is of Aboriginal and/or Torres Strait Islander descent may be referred by their GP for allied health services under items 81300 to 81360 when the GP has undertaken a health assessment and identified a need for follow-up allied health services.

Items 81300 to 81360 are available in addition to items 10950-10970 or they provide an alternative pathway to allied health services for Aboriginal and/or Torres Strait Islander people.

Item Description

81300

Aboriginal or Torres Strait Islander Health Service provided by an eligible Aboriginal Health worker

81305

Diabetes Education

81310

Audiology Health Service

81315

Exercise Physiology

81320

Dietetics

81325

Mental Health Services

81330

Occupational Therapy

81335

Physiotherapy

81340

Podiatry

81345

Chiropractic

81350

Osteopathy

81355

Psychology

81360

Speech Pathology

Referral Templates

Eligible Practitioners
Items 81300 to 81360 can only be claimed for services provided by eligible allied health professionals who meet eligibility requirements, are in private practice and registered with Medicare Australia. There are specific eligibility requirements for allied health professionals providing services under these items and full item descriptions should be reviewed before undertaking these services.

Services provided by eligible allied health professionals under these items must meet the requirements set out in the item descriptors. These requirements include:

  • Service is of at least 20 minutes duration;
  • Service is provided to the person individually (i.e. not as part of a group service) and in person (i.e. the allied health professional must personally attend the patient);
  • Person is not an admitted patient of a hospital; and
  • After the service the allied health professional must provide a written report to the GP.

For further information, please contact the SEA-GP Closing the Gap Program Officers.

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Immunisation

Through vaccination initiatives we have a simple, timely, effective and affordable means by which to impact upon Aboriginal and Torres Strait Islander health, and a pathway via which we can support significant positive outcomes for mums, infants, youth and Elders. Immunisation against preventable diseases is one important aspect in the complex of health, social and environmental factors that can contribute to the wellbeing of Australia’s Aboriginal and/or Torres Strait Islander peoples and our culture Information about vaccination programs for Indigenous children and adults is available from the Department of Health and Ageing Immunise Australia Program.

Further information is also available from: Website - www.immunise.health.gov.au

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RACGP Standards for General Practice

  • Currently being updated

 

For further information, please contact the SEA-GP Closing the Gap Program Officers.

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  • Are you of Aboriginal or Torres Strait Islander Origin?....To find out we need to ask you  ABS Brochure that can be used in your practice for patients. For more information and copies contact National Centre for Aboriginal and Torres Strait Islander Statistics 1800 633 216

  • Aboriginal? Torres Strait Islander Origin? Do you know?  ABS Brochure that can be used in your practice for staff. For more information and copies contact National Centre for Aboriginal and Torres Strait Islander Statistics 1800 633 216

 

Immunisation

  • Information and resources available on www.immunise.health.gov.au – click on  "Aboriginal and Torres Strait Islander People". 

 

 

Clinical Guidelines

  • Alcohol treatment guidelines for Indigenous Australians (Resource Package)
    Australian Department of Health and Ageing; Canberra: 2007
    Available at:  www.alcohol.gov.au  (Alcohol Resources & Publications - Aboriginal and Torres Strait Islander Health Products)

  • Guidelines for Preventative activities in General Practice (RACGP Red Book)
    Royal Australian College of General Practitioners (RACGP), (Current Edition).
    Available at:  http://www.racgp.org.au/guidelines/redbook

  • Putting Prevention into Practice - Guidelines for the Implementation of Prevention in the General Practice setting (RACGP Green Book)
    Royal Australian College of General Practitioners (RACGP), (Current Edition)
    Available at: http://www.racgp.org.au/guidelines/greenbook

 


This page provides a range of useful links to various websites supporting Aboriginal and Torres Strait Islander Australians.


ABC Health and Wellbeing – Your Health, Indigenous Health

Aboriginal and Islander Community Health Service Brisbane Limited (AICHS)
The Aboriginal and Islander Community Health Service (AICHS), Brisbane Ltd aim to raise the health status of Aboriginal and Torres Strait Islander peoples by providing holistic health care to the community.

Australian Bureau of Statistics (ABS) – National Centre for Aboriginal and Torres Strait Islander Statistics (NCATSIS)
The Australian Bureau of Statistics is Australia's official statistical organisation. It assists and encourages informed decision-making, research and discussion within governments and the community, by providing a high quality, objective and responsive national statistical service.

Australian Drug Information Network (ADIN)
The Australian Drug Information Network (ADIN) searches quality assured web-based alcohol and other drug information (Australian and International). Includes a link to comprehensive information for Indigenous communities.

Australian Indigenous HealthInfonet
The Australian Indigenous HealthInfoNet provides comprehensive, up-to-date knowledge and information accessible to people interested in the health of Indigenous Australians. Includes the Australian Indigenous HealthBulletin.

Australian Institute of Health and Welfare (AIHW) – Indigenous Australians
Australia's national agency for health and welfare statistics and information.

Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS)
An independent Commonwealth Government statutory authority devoted to Aboriginal and Torres Strait Islander studies.

Close the Gap

Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA)
FaHCSIA, through its Office for Indigenous Policy Coordination, is responsible for coordinating a whole of government approach to programs and services for Indigenous Australians, and has a central role in the Australian Government's arrangements in Indigenous Affairs.

Department of Health and Ageing, Closing the Gap – Tackling Chronic Disease

Human Rights and Equal Opportunity Commission (HREOC) - Aboriginal & Torres Strait Islander Social Justice
HREOC advocates for the rights of Indigenous Australians and works to promote respect and understanding of these rights among the broader community.

Indigenous Portal
The Indigenous Portal is your window to resources, contacts, information, and government programs and services for Aboriginal people and Torres Strait Islanders. The Indigenous Portal is one of several Australian Government customer-focused portals providing access to services and information, arranged around a single entry point.

Institute for Urban Indigenous Health (IUIH)
IUIH provide support for Aboriginal and Torres Strait Islander health service development and coordination across the South East Queensland Region

Journal - Medical Journal of Australia (MJA) – Aboriginal Health Articles

Medicare Australia – Indigenous Health

National Aboriginal Community Controlled Health Organisation (NACCHO)
The national peak Aboriginal and Torres Strait Islander health body. It has a membership of around 100 Aboriginal community controlled health services throughout Australia, which operate in urban, rural and remote areas.   NACCHO represents the health interests of Aboriginal communities at the national level. It promotes holistic and culturally appropriate health to Aboriginal communities.

Office of Aboriginal and Torres Strait Islander Health (OATSIH)
Listing of Aboriginal Medical Services in each State and Territory

Oxfam Australia - Indigenous Australia

Queensland Aboriginal & Islander Health Council (QAIHC)
QAIHC is the state peak body representing the Community Controlled Health Sector in Queensland at both state and national level.

Queensland Government – Indigenous Information and Services

Queensland Health – Indigenous Health
Information for Health Professionals on Indigenous Health

Reconciliation Australia

Rural Health Education Foundation (RHEF) – Aboriginal Health Education Programs
RHEF provide health education via satellite, the Internet and DVD / Video. A number of education program have been developed which focus primarily or substantially on Aboriginal Health.

Secretariat of National Aboriginal and Islander Child Care (SNAICC)
The national non government peak body in Australia representing the interests of Aboriginal and Torres Strait Islander children and families.

Statistics Publication – Population Distribution, Aboriginal and Torres Strait Islander Australians – ABS Statistics 2006 Census